Applicant Signature. I hereby certify that, to the best of my knowledge, all the information provided in this Interconnection Request is true and correct. For Interconnection Customer: Date: Attachment 3 Certification Codes and Standards ANSI C84.1-1995 Electric Power Systems and Equipment – Voltage Ratings (60 Hertz) IEEE 1547, Standard for Interconnecting Distributed Resources with Electric Power Systems (including use of IEEE 1547.1 testing protocols to establish conformity) IEEE Std 100-2000, IEEE Standard Dictionary of Electrical and Electronic Terms IEEE Std 519-1992, IEEE Recommended Practices and Requirements for Harmonic Control in Electrical Power Systems IEEE Std C37.108-1989 (R2002), IEEE Guide for the Protection of Network Transformers IEEE Std C37.90.1-1989 (R1994), IEEE Standard Surge Withstand Capability (SWC) Tests for Protective Relays and Relay Systems IEEE Std C37.90.2 (1995), IEEE Standard Withstand Capability of Relay Systems to Radiated Electromagnetic Interference from Transceivers IEEE Std C57.12.44-2000, IEEE Standard Requirements for Secondary Network Protectors IEEE Std C62.41.2-2002, IEEE Recommended Practice on Characterization of Surges in Low Voltage (1000V and Less) AC Power Circuits IEEE Std C62.45-1992 (R2002), IEEE Recommended Practice on Surge Testing for Equipment Connected to Low-Voltage (1000V and Less) AC Power Circuits NEMA MG 1-1998, Motors and Small Resources, Revision 3 NEMA MG 1-2003 (Rev 2004), Motors and Generators, Revision 1 NFPA 70 (2002), National Electrical Code UL 1741, Inverters, Converters, Controllers and Interconnection System Equipment for Use With Distributed Energy Resources Attachment 4 Certification of Generator Equipment Packages
Applicant Signature. I certify that I have read and understood the notices in Section 1 and, that to the best of my knowledge, the information provided on this form is true and correct. Signature of Applicant Date (mm/dd/yyyy)
Applicant Signature. I hereby certify that, to the best of my knowledge, all the information provided in this Interconnection Request Application Form is true and correct. For Interconnection Customer: Signature (Authorized Agent of the Legal Entity) Date: Print Name Attachment 4 SAMPLE SITE CONTROL VERIFICATIONFORM In the Matter of the Application of ) [Developer Name] for an ) SITE CONTROL VERIFICATION Interconnection Agreement ) with [Utility Name] ) I, [Authorized Signatory Name], [Title] of [Developer Name], under penalty of perjury, hereby certify that, [Developer Name] or its affiliate has executed a written contract with the landowner(s) noted below, concerning the property described below. I further certify that our written contract with the landowner(s) specifies the agreed rental rate or purchase price for the property, as applicable, and allows [Developer Name] or its affiliates to construct and operate a renewable energy power generation facility on the property described below. This verification is provided to [Utility Name] in support of our application for an Interconnection Agreement. Landowner Name(s): Land Owner Contact information (Phone or e-mail): Parcel or PIN Number: County: Site Address: Number of Acres under Contract (state range, if applicable): Date Contract was executed Term of Contract [signature] [Authorized Signatory Name] [Authorized Signatory Name], being first duly sworn, says that [he/she] has read the foregoing verification, and knows the contents thereof to be true to [his/her] actual knowledge. Sworn and subscribed to before me this day of , 201_. [signature] [Authorized Signatory Name] [Title], [Developer Name] [Signature of Notary Public] Notary Public Name of Notary Public [typewritten or printed] My Commission expires Attachment 5 Certification Codes and Standards ANSI C84.1-1995 Electric Power Systems and Equipment – Voltage Ratings (60 Hertz) IEEE 1547, Standard for Interconnecting Distributed Resources with Electric Power Systems (including use of IEEE 1547.1 testing protocols to establish conformity) IEEE Std 100-2000, IEEE Standard Dictionary of Electrical and Electronic Terms IEEE Std 519-1992, IEEE Recommended Practices and Requirements for Harmonic Control in Electrical Power Systems IEEE Std C37.108-1989 (R2002), IEEE Guide for the Protection of Network Transformers IEEE Std C37.90.1-1989 (R1994), IEEE Standard Surge Withstand Capability (SWC) Tests for Protective Relays and Relay Systems IEEE Std C37.90.2 (1995), IEEE Standa...
Applicant Signature. I hereby certify that, to the best of my knowledge, all the information provided in this Interconnection Request is true and correct. For Interconnection Customer: By (signature): Name (type or print): Title: Company: Date: ATTACHMENT A TO APPENDIX 2 – SMALL GENERATOR INTERCONNECTION REQUEST– Terms and Conditions of Interconnection Study(ies) These terms and conditions for the study of a Small Generating Facility or material modification to an existing Small Generating Facility proposed in the Interconnection Request dated __________(“the Project”)_and submitted by ________________________________________, a __________________ organized and existing under the laws of the State of _____________ (“Interconnection Customer”) sets forth the respective obligations between Interconnection Customer and the New York Independent System Operator, Inc., a not-for-profit corporation organized and existing under the laws of the State of New York (“NYISO”) (hereinafter the “Terms and Conditions”). By signing below, Interconnection Customer confirms its understanding and acceptance of the Terms and Conditions.
Applicant Signature. I fully understand the attendance and tuition requirements for the Xxxxxxxxxxx Xxxxxx Leadership Development program and agree to fulfill those requirements if selected. APPLICANT’S NAME AIA #: APPLICANT’S SIGNATURE DATE Firm Principal Signature: I authorize and encourage the above applicant to participate fully in the Xxxxxxxxxxx Xxxxxx Leadership Development program and fully understand the attendance requirements as outlined above. SIGNATURE OF FIRM PRINCIPAL DATE
Applicant Signature. I hereby certify that, to the best of my knowledge, all the information provided in this Interconnection Request is true and correct. For Interconnection Customer: Date: Attachment 3 Feasibility Study Agreement THIS AGREEMENT is made and entered into this day of 20 by and between , a organized and existing under the laws of the State of , ("Interconnection Customer,") and ("Transmission Provider"). Interconnection Customer and Transmission Provider each may be referred to as a "Party," or collectively as the "Parties."
Applicant Signature. I fully understand the attendance and tuition requirements for the Xxxxxxxxxxx Xxxxxx Leadership Development program and agree to fulfill those requirements if selected. APPLICANT’S NAME AIA # APPLICANT’S SIGNATURE DATE Firm Principal Signature: I authorize and encourage the above applicant to participate fully in the Xxxxxxxxxxx Xxxxxx Leadership Development program and fully understand the attendance requirements as outlined above. SIGNATURE OF FIRM PRINCIPAL DATE PRINTED/ TYPED NAME AND TITLE OF FIRM PRINCIPAL Contact: For more information please visit the AIA Miami website xxx.xxxxxxxx.xxx, the AIA Fort Lauderdale website xxxxx://xxx.xxxxxxxxxxxxxxxxx.xxx/ or contact the 2024 CKLDP Executive Committee.
Applicant Signature. Date ...... / ....... /.......
Applicant Signature. Date: Sworn to and subscribed before me, On this the day of , 20 Notary Public Signature
Applicant Signature. The remainder of the form is to be completed by the District/Employer reporting the information. (To be completed by Official/Supervisor) Work Year Position/Title # of days worked by this employee Hours this employee worked per day Contracted Employee Substitute Employee Sick leave accumulation at the time of separation: (Official use only) Completed by: Title Address: Date: Please return completed form to: XxXxxx Xxxxx, Human Resource Director The Omak School District #19 complies with all federal rules and regulations and does not discriminate on the basis of sex, race, creed, religion, color, national origin, age, honorably discharged veteran or military status, sexual orientation including gender expression or identity, the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal by a person with a disability in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. This holds true for all district activities, programs, and employment opportunities. The following employee has been designated to handle questions and complaints of alleged discrimination: Title IX/RCW 28A.640/RCW28A.642 Officer, XxXxxx Xxxxx (000) 000-0000, Section 504/ADA Coordinator, Xxxx Xxxxxxx (509) 826- 8143, and/or Compliance Coordinator for State Laws RCW 28A.640 Sexual Equality and RCW 28A.642 Discrimination Prohibited Officer, XxXxxx Xxxxx (000) 000-0000. Omak School District is a drug- and tobacco- free workplace. For more information on Omak School District’s Affirmative Action Plan, please visit the “District Information” section located under “Our District” on the Omak School District website at xxx.xxxxxx.xxx.
